The dose starts low and rises in steps roughly every four weeks. That schedule exists entirely to keep side effects manageable, and the single biggest determinant of a good experience is being willing to hold a step rather than push through it.
The starting dose is not intended to produce weight loss. It is intended to let your digestive system adapt to a signal it has never had held steady before. Skipping that step is how people end up with a fortnight of nausea.
Each increase reintroduces the same adjustment on a smaller scale, which is why symptoms often reappear for a few days after every step and then fade.
Long enough for the body to adapt and for the effect at that dose to be judged fairly.
Review before each increase
Side effects, weight trend and how you are eating. The increase is a decision, not an automatic event on a calendar.
Hold when it is not settled
Staying at a dose for six or eight weeks is common and is not a setback. Pushing a dose that has not settled reliably makes things worse.
Stop at what works
If the weight is coming off steadily at a middle dose, there is no reason to keep climbing. The highest dose is not the goal.
Maintenance
What the maintenance dose means
Once you reach a dose where weight is coming off at a sensible rate and side effects are tolerable, that becomes your maintenance dose. It may be well below the maximum, and that is a good outcome rather than a compromise.
Maintenance is also the dose most people stay on if they continue treatment after reaching their target, because the appetite effect only lasts while the medication does. The detail sits in Stopping medication, Weight loss timeline and Medication cost.
Steady, tolerable lossGoal
The maximum doseNot the goal
Holding for longerCommon
Guides
Related dosing guides
The mechanism, month one, the timeline and stopping.
How fast the dose rises, holding, and whether the maximum matters.
Roughly every four weeks, provided the current dose has settled. If side effects are still active, holding longer is the standard adjustment and does not mean the treatment is failing.
No. If weight is coming off steadily at a middle dose with tolerable side effects, that is your maintenance dose. The highest dose is a ceiling, not a target.
Stepping back down to the previous dose is normal and is done regularly. It is far better than abandoning treatment because one step was too much.
It is not advisable. Faster escalation is the most reliable way to produce severe nausea, and it does not produce faster weight loss in the medium term.
There is guidance for this depending on how long ago the dose was due. Ask rather than guess, and do not double up to catch back up.
